New trial to prevent blindness in children with arthritis

6th April 2011

Doctors are planning a major UK-wide clinical trial which they hope will prevent blindness in children with arthritis.

With funding of £1.5m from Arthritis Research UK and the National Institute for Health Research Health Technology Assessment (NIHR HTA) programme, the trial aims to recruit more than 150 children with juvenile idiopathic arthritis (JIA), who are at risk of uveitis, a serious inflammatory eye condition which in severe cases can lead to blindness.

The study will be run by chief investigators Dr Athimalaipet Ramanan, lead consultant in paediatric rheumatology at Bristol Royal Hospital for Children, and Dr Michael Beresford, senior lecturer in paediatric medicine and honorary consultant paediatric rheumatologist, at Alder Hey Children’s NHS Foundation Trust.

The trial will test the effectiveness of a powerful biologic drug called adalimumab, which is currently licensed to treat adults with rheumatoid arthritis, and teenagers between the ages of 13 and 16 with JIA.

However, doctors hope that if they can show the drug to be both safe and effective in reducing uveitis, it could also be approved for use in children with arthritis of all ages, in a range of doses.

JIA is a form of inflammatory joint disease that affects around 15,000 children and teenagers between the ages of six months and 17 years.

Fourteen paediatric rheumatology centres in the UK will start recruiting youngsters in the summer. Participants will stay on the treatment for at least a year.

“Up to 30 per cent of children with JIA are at risk of uveitis, and in one third of these children, the disease is of sufficient severity to cause visual loss, cataracts, increased pressure in the eye and blindness,” explained Dr Ramanan. “If this trial shows that adalimumb is effective, it would be great news for children with JIA whose eyes are affected.”

Current treatments are steroid eye drops, and for those with severe disease, a drug called methotrexate, which is a standard treatment for inflammatory forms of arthritis. Neither is a cure, but both relieve symptoms to some extent.

The trial will test the effectiveness of giving adalimumab, given per injection every two weeks, with methotrexate - which is known to be effective in treating the symptoms of inflammatory arthritis - compared to methotrexate on its own. Earlier, small studies have shown that children taking adalimumab have shown significant improvement in their uveitis.

Funding for the Arthritis Research UK part of the trial has been provided by a private donor.